Patient Safety and Quality

In October 2008, CMS discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. A new study did not find evidence that the CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measureable effect on these infection rates in U.S. hospitals. There were no subgroups of hospitals where patients appeared to benefit from the implementation of this policy change. The study was based on data from 398 hospitals in 41 States ranging from small, nonteaching community hospitals to large academic medical centers. The findings did not differ for hospitals in States without mandatory reporting, nor did they differ according to the percentage of Medicare admissions.

The researchers examined changes in trends for these two healthcare-associated infections (HAIs) that were targeted by CMS policy by looking at a total of 398 hospitals or health systems and 14,817 to 28,229 hospital unit-months, depending on the type of infection. The researchers point out that there were already strong downward trends for targeted HAIs well before the implementation or announcement of the CMS policy. Also, since ICD-9 diagnostic codes assigned by billing data were the metric used by CMS, hospitals may have focused greater effort on improving documentation and coding of infections as "present on admission" than on preventing hospital-acquired infections. Thus, billing data may not reflect the underlying quality of care at institutions. Some of the infections were already areas of focus for other improvement initiatives. Finally, since reductions in CMS payment may have been equivalent to as little as 0.6 percent of Medicare revenue for the average hospital, the lack of effect may be due to the very small financial incentives at stake. This study was supported by AHRQ (HS18414).

See "Effect of nonpayment for preventable infections in U.S. hospitals," by Grace M. Lee, M.D., Ken Kleinman, Sc.D., Stephen B. Soumerai, Sc.D., and others in the New England Journal of Medicine 367, pp. 1428-1437, 2012.